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Death: Fighting It or Embracing It? Part One By Thomas Lorenz

Thursday, 13 Feb 2014 21:07

If one were to plot a person’s life on a number line, then death would be nothing more than an infinitesimally thin point, nothing more than a nanosecond demarcation from one state of being to another state of being. So why is it that some of us fight death with our last full measure while others embrace it like a new born baby? Have you thought of your death lately and asked yourself how your impressions of death were formed? Just how did you learn what you know about death? Perhaps you’ve felt conflicted in your views of death as I once did. In this two-part article I will briefly share what I believe to be the sources of that confusion: Religion, Medicine, Technology, Pharmaceuticals, Commercials, TV and Hollywood, social colloquialisms, and an absent education system.

The only clarity I’ve gotten on death has come from Webster and my own experiences. Webster describes death as a noun, “an act or fact [of dying]” while dying is described more as a process “to lose force or activity, become weak, faint, and unimportant, etc.” In the minds of many, death the noun and dying the transitive verb are often confused and used interchangeably, yet when people speak of their fear of death they primarily speak of agony and pain, which are characteristics associated with the dying process, not death the noun.

Most of the major religions discuss death but not dying. So religion may not lend much clarity, but it may help in the art of acceptance. Raised in the Christian tradition, as a child I became confused when I learned of death as “a wage or consequence”. Death was also naturalized by having a “sting”, and I so hated bee stings, avoiding them at all costs. So naturally, I learned to hate and avoid death. In the Holy Bible, death has many descriptions such as: “destroyer”, “thief”, and “robber” just to name a few of such ominous titles. Then, confusion was amplified when I was told that eternal life was gained for all, by the death of one. So, was death a bad thing that I should fight or a good thing that I should embrace? I didn’t know.

From a scientific perspective, there is little room for argument that we are an “anti-death” society. Quite possibly, we would be better served to live our lives as “anti-dying”– by making better lifestyle choices near the end of life. All we need to do is to view the statistics on dollars spent by Medicare. It is fortunate for acute care institutions that there are no Medicare spending figures to track the dollars spent on acute care procedures that would have been more effectively spent on hospice. What is documented is that in 2012 Medicare spent a total of $522 Billion on health care. Medicare dollars spent on aged persons was 77% of that total which calculates to $401 Billion, (MedPAC Report, 2013). In-patient hospital expenditures, for this population, according to MedPAC were 25% or $100 Billion (MedPAC Report, 2013, see below). In contrast, Medicare spending on hospice was 3% or about $13.8 Billion (MedPAC Report, 2013). Hospice spending grew from 2006 by only 1% while total Medicare spending grew from 2006 by 30%.

There can be no doubt of the unholy alliance of medicine, technology, and pharmaceuticals to wage relentless war, in a vain attempt to prevent the inevitable outcome of death. In my personal life, if my family or friends observed me spending every penny on an outcome that I could not change, they would label me ‘crazy’. Yet this alliance has convinced the masses that we should push out the inevitable as long as possible, at any cost.

Many life extending products and procedures which we have come to depend upon have come from this alliance such as: artificial organs, replacement procedures, wonder drugs, screening and testing technologies, chemical therapies, laser surgeries, and many more. I have been a benefactor of these modern wonders, and I have the video of my gall bladder operation (something that would have caused me to die at 36 years of age a century ago) to prove it. How sexy is that!? I’ve shown it at parties so my friend can know me “inside and out”.

Why do we spend so much treasure on extending life when the outcome is inevitably death, and so little treasure on ensuring patient-centered symptom management so that death arrives as pleasantly and painlessly as possible? In the U.S., it can be difficult to determine whether medicine serves the patient or the industry. Most U.S. medical school curricula focus on teaching our young doctors how to cure. Only recently have some medical schools required coursework on aging, managing pain, and palliative care as graduation requirement.

We may discover that the origins of our “fight” or “embrace” death mentality lie in a TV show, a favorite movie, or fun tradition. In a famous movie line (“Oh God!” with renowned comic George Burns) it was said, “Everybody wants eternal life but nobody wants to die to get it.” And who can forget the dashing Captain Kirk who on several post-trauma occasions told his medical officer Dr. “Bones” McCoy, “I didn’t beat death, I only cheated it,” as if death is a player at a poker table. Like the CSI series and many other shows where complicated crimes and medical situations, that normally lead to death, are solved with wizard-like technology and last minute heroics, (all in an hour or less) we have begun to have the same sexy Hollywood expectations of our real life health system. Huey Lewis sung about it in his 1980’s smash hit, “I Want A New Drug” to cure his lack of confidence when he’s with a new woman. Hey Huey, how about giving honesty a try! Honesty, now there’s an eternity pill for the taking. Honesty often is a bitter tasting medicine, but oh “how sweet it is”, as Jackie Gleason would say, when we finally know the truth! Billy Joel craves it in his song, “Honesty”.

So who do you think has more honesty: institutions and vendors making money from the avoidance of death, or your local Hospice who works tirelessly to help you and your loved one manage a good death experience? When it is your time, or your loved one’s time, will you cast your vote in the direction of money-laden-avoidance-institutions to counsel you on the best end (telling you about the latest and greatest “last shot”), or, will you cast your vote for the Hospices and other non-profits who’s goal it is to see you have a satisfactory and peaceful ending?

(So as you go about your busy week please think of your stereotypes for death, where they come from, and which way you would vote: fight or embrace? Next week we’ll conclude this topic with a look at stereotypes created by society and public education, as well as the author’s personal care giving story, detailing how he came about his own fight versus embrace decision.)

Thomas Lorenz has a Master’s Degree in Gerontology, Management of Aging Services from the University of Massachusetts, Boston. He is a passionate writer for many aging issues blogs on LinkedIn, and owner of www.behome4ever.com which is the website for his company- dedicated to keeping seniors in their homes. Tom enjoys assessing homes and writing home modification recommendation plans for safety, age in place, disability, frailty, sensory impairment, dementia, and designing care transition plans, technology assistance plans, and EMS response plans for seniors and adult children in distress from complicated health and social systems. He was a part-time care giver for both parents and was moved by his care giving experiences to retire early from public education, where he taught mathematics, to devote his life to developing solutions for seniors and their adult children. Tom is also a retired Base Electronics Systems Engineering Planner where he worked on the U.S. Navy program popularized by the movie “Hunt for Red October”. Please see his website to contact Tom directly

"It's OK to Die" is a ground-breaking book filled with graphic stories straight out of the Emergency Room illustrating how most Americans are completely unprepared for death and dying. In response, the authors have created a unique and comprehensive guide urging EVERYONE to prepare in advance, to assure their own peace and to prevent the suffering of their loved ones. Learn More..

Perhaps it (hospice, and medical intervention) is all for the purpose of Love. Our society has been (as often required) more bent on making a living, with less time spent on the deeper elements of Love. To die without having loved enough, or having been loved enough is perhaps what God is trying to prevent—by extending our busy lives. No matter what I accomplish in life, it is all useless without Love.

I have noticed that many of my closest friends died young, and yet they really had a handle on Love–in my eyes. They spoke precious things to me, such as advice on how to have the best relationships possible. I was very young at the time, and did not have the wisdom to really know what they were saying.

“Many a tear will fall” as we learn to choose what is more loving in each situation,— medical interventions, or the hospice, or a bit of both. Thank God for Dr Murphy our eyes are more open to the truth about the last possibility of a glorious finish within the context of our imperfect bodies..

“Many a tear will fall”–from the song–“Its all in the game of Love”. Perhaps as we near the end its no longer a game.

To clarify the last sentence of my last post as follows: “Many a tear will fall” from the song “Its all in the game”, by the honorable Tommy Edwards on 7/11/1958. Perhaps the closer we get to the end, Love becomes less of a game—for society as a whole. It becomes more of a priority.

Robert, I agree with you that as we get closer to our end love becomes paramount, but here is the kicker…you’ve got to know you are near (or your loved one is near their end) to really activate the human heart (for most ). What this then requires is a doctor or other person who has the guys to tell you that you are near the end of life. Then an emotional and spiritual window of opportunity opens unlike others in life.

I agree Monica. I hope that when my time comes there will be honesty in my communications. I like Robert’s “a little bit of both medical and hospice” approach as long as I have a reasonable chance of doing things for myself for a while. If not, then honesty about what I can expect from that point on. I don’t want to be someone’s lab rat, honestly!

Yes! It’s okay to die and we all have this appointment that can only be postponed. Not surprising that humans, like all of the species that occupy the earth have a fear of death and fight for their lives whenever possible. This is instinctive! The state, in the law, in the United States has always supported “life” over “death” as serving the greatest public good. In Christianity and other religious for many years, suicide was treated as a sin and was an illegal act. In places like Japan, suicide was considered an honorable act when it spared the family disgrace or shame. The United States Congress in 1997 passed a law that prohibits using public funds for assisted suicide, mercy killing, euthanasia, etc.. but suicide itself is no longer against US law and Assisted Suicide (physician assisted) has been approved in three states to date.

Advanced directives were introduced by the 1991 Patient Self Determination Act with the goal of preventing cruel over treatment of elderly/disabled Medicare/Medicaid patients and saving money for Medicare and the private insurers when elderly and terminal patients would ELECT/CHOOSE to reject any further life-saving and life-extending treatments and shorten their lives in order to shorter their suffering from certain death from the terminal disease. The 1991 PSDA together with the 1986 Hospice entitlement created another legal standard of care that is reimbursed by Medicare. However, the for-profit physicians and clinics were NOT placed under the provisions of the 1991 PSDA and the states did not implement the goals of the 1991 PSDA and the Hospice entitlement has not provided the savings that the government anticipated.

I will be 87 in a few months and I think about death a lot and blog almost every day because of a terrible experience my husband and I had with a unilateral and covert Do Not Resuscitate Status (DNR) that was extrapolated into my husband’s hospital chart —of course without OUR informed consent. This was such a shock to both of us; i.e., that the physician and the hospital would cooperate to attempt to hasten my husband’s death —-and apparently for fiscal and personal expediency of the physician and the hospital.

We knew there was age discrimination in health care because my Mom, who lives with us, lived to 104-l/2, and we had to fight an insidious kind of discrimination in health care at times for her to achieve this great old age. Only the last year, when she was losing her cognitive ability, was it hard for her and hard for us. She did die on Hospice here with me at home when she was 104-l/2 but the treatment she received or didn’t receive in the hospital after a slight stroke was disgraceful.

The autonomy of the elderly on Medicare/Medicaid to choose to shorten their lives to shorten their suffering OR to choose to live to fight to live as long as possible (unless life-saving treatment is deemed to be medically futile under some due-process procedure) under the provisions of the 1991 PSDA has been eroded and I’m afraid that passive euthanasia of the elderly on Medicare/Medicaid in US hospitals for fiscal expediency is already a HARD reality.

It’s okay to die but not okay for others to remove this decision of “when” to die from the person who is doing the dying.
to serve fiscal expediency of the Insurance Companies and the Hospitals.

Realistically, patients are “product” for profit in our US Health Industry and most Hospices are now for-profit institutions and stand to gain from a new trial scheduled for 2014 wherein Medicare patients will be eligible to be on both Hospice and Curative Care at the same time with the view that patients will be referred to Hospice much earlier in the course of their terminal diseases and there will be savings for Medicare when more elderly/disabled patient die outside of expensive ICU and CCU Care, and more money and profit for Hospices when they are automatically switched over to Hospice care when curative care is no longer feasible and curative care will no longer be reimbursed by CMS and private insurance.

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